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CME

Staphylococcus aureus Bacteremia

General Information

General InformationGeneral Information

Description

  • bloodstream infection with Staphylococcus aureus1,2,3

Types

  • definitions vary among experts but common features include1,3
    • uncomplicated Staphylococcus aureus bacteremia
      • defervescence within 72 hours
      • clearance of bloodstream infection within 72 hours (demonstrated by culture)
      • no distal or metastatic focus of infection
      • absence or removal of intravascular hardware
      • no evidence of endocarditis by transesophageal echocardiography
      • no evidence of suppurative thrombophlebitis
      • removal of catheter in patients with catheter-associated infection
      • patient without active malignancy or immunosuppression
    • complicated S. aureus bacteremia
      • patient meets Duke criteria for possible or definite endocarditis
      • evidence of endocarditis
      • deep source of infection other than endocarditis (such as osteomyelitis or prosthetic joint infection)
      • persistently positive blood culture
      • patient with immunocompromise
      • failure to meet any criteria of uncomplicated bacteremia

References

General references used

  1. Thwaites GE, Edgeworth JD, Gkrania-Klotsas E, et al; UK Clinical Infection Research Group. Clinical management of Staphylococcus aureus bacteraemia. Lancet Infect Dis. 2011 Mar;11(3):208-22
  2. Lowy FD. Staphylococcus aureus infections. N Engl J Med. 1998 Aug 20;339(8):520-32, commentary can be found in N Engl J Med 1998 Dec 31;339(27):2026
  3. Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009 Jul 1;49(1):1-45full-text, corrections can be found in Clin Infect Dis 2010 Feb 1;50(3):457 and Clin Infect Dis 2010 Apr 1;50(7):1079, commentary can be found in Am J Kidney Dis 2009 Jul;54(1):13 and Clin Infect Dis 2009 Dec 1;49(11):1770
  4. Liu C, Bayer A, Cosgrove SE, et al; Infectious Diseases Society of America. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011 Feb 1;52(3):e18-55full-text, corrections can be found in Clin Infect Dis 2011 Aug 1;53(3):319 , commentary can be found in Clin Infect Dis 2011 Jun 15;52(12):1468, Clin Infect Dis 2011 Jul 1;53(1):97, Clin Infect Dis 2011 Aug 1;53(3):308, Clin Infect Dis 2015 Apr 15;60(8):1290
  5. Rongpharpi SR, Duggal S, Kalita H, Duggal AK. Staphylococcus aureus bacteremia: targeting the source. Postgrad Med. 2014 Sep;126(5):167-75

Recommendation grading systems used

  • Infectious Diseases Society of America (IDSA) grades of recommendation
    • strength of recommendations
      • Grade A - good evidence to support a recommendation for or against use
      • Grade B - moderate evidence to support a recommendation for or against use
      • Grade C - poor evidence to support a recommendation
    • quality of evidence
      • Level I - evidence from > 1 properly randomized, controlled trial
      • Level II - evidence from > 1 well-designed clinical trial, without randomization; from cohort or case-controlled analytic studies (preferably from > 1 center); from multiple time series; or from dramatic results from uncontrolled experiments
      • Level III - evidence from opinions of authorities, based on clinical experience, descriptive studies, or reports of expert committees
  • American Heart Association/American College of Cardiology (AHA/ACC) grading system for recommendations
    • classifications of recommendations
      • Class I - procedure or treatment should be performed or administered
      • Class IIa - reasonable to perform procedure or administer treatment, but additional studies with focused objectives needed
      • Class IIb - procedure or treatment may be considered; additional studies with broad objectives needed, additional registry data would be useful
      • Class III - procedure or treatment should not be performed or administered because it is not helpful or may be harmful
        • Class III ratings may be subclassified as Class III No Benefit or Class III Harm
    • levels of evidence
      • Level A - data derived from multiple randomized clinical trials or meta-analyses
      • Level B - data derived from single randomized trial or nonrandomized studies
      • Level C - only expert opinion, case studies, or standard of care
  • European Society of Cardiology (ESC) grading system for recommendations
    • classifications of recommendations
      • Class I - procedure or treatment should be performed or administered
      • Class IIa - reasonable to perform procedure or administer treatment, but additional studies with focused objectives needed
      • Class IIb - procedure or treatment may be considered; additional studies with broad objectives needed, additional registry data would be useful
      • Class III - procedure or treatment should not be performed or administered because it is not helpful or may be harmful
        • Class III ratings may be subclassified as Class III No Benefit or Class III Harm
    • levels of evidence
      • Level A - data derived from multiple randomized clinical trials or meta-analyses
      • Level B - data derived from single randomized trial or nonrandomized studies
      • Level C - only expert opinion, case studies, or standard of care
    • Reference - European Society of Cardiology (ESC) guideline on prevention, diagnosis, and treatment of infective endocarditis can be found in 19713420Eur Heart J 2009 Oct;30(19):2369full-text
  • American College of Radiology (ACR) rating scale
    • Rating 1, 2, and 3 - usually not appropriate
    • Rating 4, 5, and 6 - may be appropriate
    • Rating 7, 8, and 9 - usually appropriate
    • Reference - ACR 2014 Appropriateness Criteria on suspected infective endocarditis (ACR 2014 PDF)

Synthesized Recommendation Grading System for DynaMed Content

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How to cite

National Library of Medicine, or "Vancouver style" (International Committee of Medical Journal Editors):

  • DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T905775, Staphylococcus aureus Bacteremia; [updated 2018 Nov 30, cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T905775. Registration and login required.

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